Michael Hardner

What did the higher tax rates pay for then ? We spent ours on universal healthcare.

Ok. That seems clear but from this: It doesn't sound like they had an idea what was needed, or what the goals were for their project. Ok. Seems like this project is somehow tied to keeping the NP in town or something. Why do they need the NP to be able to write prescriptions ? Are there others in town that do that now ? Like I said - there should be a catalogue of what is provided, how many people are served, and costs, and who is paying for it. It should be online and the data should be provided from data that is already collected. Exactly. Artificial agencies ostensibly created to 'manage' things end up confusing things. We are - in business speak - stakeholders. If the system is a mess (and I believe that it is) then we need to push the hot button on something.

They ... built a building in order to keep the nurse there ? "We don't want you to quit, so we built you a new building ?" The would have worked perfectly because ... she could have written prescriptions ? I don't get that either. They had to build a building because now they don't have to bring in somebody from outside to immunize students ? It all sounds overly complex and politically motivated to me. Also over managed. Overly complicated and byzantine arrangements to me. I would say that a new planning authority needs to be started that supplants other areas of concern. There should be a standard table of information for each facility that shows the costs and benefits for each project. The press releases are interesting but it's only one face of what is happening. In business, they have reports that indicate the cost per customer, the waiting time per customer and so on. Managers use this information to decide what's working and what isn't.

We are kindred spirits then. Although my politics are centre-left I have worked in business management (IT) and organization is my area of interest. Press releases are a common form of communication about Healthcare. Not the best, however the ones you have here are better than the Ontario PR items I have read. They have the amount being spent - basically "we're spending $400K to build a healthcare facility". The outlined information is there. It's very basic though.

Uh. The page doesn't have anything but a picture and short description of the facility. What about a link to the project. And how do you know so much about various clinics and so on to be able to rhyme off the services that are provided ? Do you have a relative who works there ? I'm not trying to be suspicious here, but trying to find out the basis of your knowledge as its relevant to the discussion.

That sounds good. Do you have a link ?

Socially, the drift goes leftward... fiscally it goes rightward.... If you don't believe me then look up social conditions in the deep south in the 1950s then look up the top marginal tax rates. They needed money to pay for building the Interstate system, defense and Hoover's dresses.

From the OP: As a Senate candidate if we're sitting here trying to glean what he was trying to say then he's a huge failure at communicating. What he was trying to say is that he's a bare knuckle libertarian. Business rules, period. Then later he tried to say something else. When the legislation was being passed in the 1950s and 1960s business opposition was a significant force in trying to shut it down.

Ok, let's see: I don't see these changes as being that imaginative. I don't agree with the % of budget metric. I'm interested in raw dollars spent per person, and services provided. Also in where the money goes. If I had enough insiders, then I would start a club to have somebody explain it to us.

I don't think anything of anybody's views on gay marriage, for the most part. People have their own reasons for being against it. What criticism have I made ? None. If people are against it, then that's their business. You seem to think I have said something against the Catholics, but that's your imagination talking.

Sorry, I didn't get that from your post. We have an opportunity with the web to open things up to public scrutiny. The disorganization and duplication of services that you often hear about may be examined if things were more visible.

Came across this by the by - Conservative blogger Bruce Bartlett is a well connected mainstream conservative. Here's his take, which follows a brief and very informative primer on the major milestones of civil rights legislation, and the constitutional implications. Bruce Bartlett's Blog

Is this about 407 ETR again ?

This is why I continue to think you have some kind of inside angle, as this type of futility is usually expressed by those inside the gates, who have no imagination. Of course costs can be reduced, service can be improved and waste can be taken out of the system. If you disagree with me, then show me some statistics. Oh right... we don't have good statistics. Like the hospital administrator who didn't consult outside the system for years, it sometimes seems like there are no answers but it's not so.

Interesting take. I usually try to either make the anchor post of a thread substantial - if it's about a new topic or something that deserves attention, OR I make it just a "what do you think of this" type comment if it points to a linked story. People do care about healthcare in a pervasive and general way, but they don't care enough to pay extra attention to the details and to invest effort into tracking things. I don't want to convey the idea that anybody would say "I don't care about healthcare." That's clearly not what's going on. What is going on is that people aren't aware that they have the ability to make things better by investing attention in the details of how services are delivered. And there's a gap in tools there that would allow people to pay attention as well. It's a tall order, but I would like people to start asking "where are the graphs ?" and "why is my hospital not included in this report ?". "Why are these surveys taken so infrequently ?". It's a tall order, but if people don't want privatization or two-tier then they have to provide all the energy and management oversight that naturally comes when there is competition.

All of us - especially those in favour of public healthcare - need to stir things and start throwing stones at the system. Too often, we simply are satisfied with "it's better than the US system". There's no surer way of assuring its collapse than comparing it to something completely different. With regards to the indifference on the topic - get a load of all the replies when I started this topic last Canada Day. http://www.mapleleafweb.com/forums//index.php?showtopic=14437&view=&hl=ehealth&fromsearch=1 I stopped posting about it after that. If MapleLeafWeb isn't interested, then nobody is.

While I do meet Americans who are enamoured of Canada - and our spelling - they tend to be North East college-educated liberal types. Where are you from again ? Did you go to post secondary education ? Are there right-wing schools there ?

CIHI is good, but not well known and they don't provide regular and simple reports that are understandable. Also, they've been doing this for awhile now and their reports tend to reflect the problems that are out there. I would prefer some kind of information that would force change back onto the system it reports on and that's not going to happen with CIHI. FCPP ? Is that Frontier Centre for Public Policy ? They seem like a think-tank kind of one-off report generating organization who will shock the system with random news releases from time to time but still not what we need. OECD ? Organisation for Economic Co-operation and Development ? That would be sad if we had to rely on international agencies to tell us how we're doing. Admittedly, my perspective is Ontarian. I don't want there to be a problem where there isn't one, but there is one in Ontario - and that's that nobody knows what is going on, and nobody has the slightest idea of how to find out. The public won't "get it" is a condescending approach. Although I'm given to thinking that myself, we have to trust a basic intelligence of the public and that would certainly be possible in the case of presenting performance stats that even lowly CEOs could understand. Please do provide links to Manitoba reports and I will check them out. I have a sincere interest in this, as I feel that if Canada ever "got" the bug to hold our government to a higher standard there would be a new quiet revolution that could propel us to a new level. I'm suspicious, I must admit, of your knowledge of this. I have posted on this here and on other boards as well as my blog for years and the only ones ever interested tend to be 'insiders'. I also happened to meet a guy who worked for the McGuinty government once, who was charged with measuring the effectivenss of their PR. By the end of that evening, I had exhausted him with my criticisms of how government is run... I don't think he was expecting me to have such strong opinions on the topic of public information management (he he he ) and very much talked down to me for the first 20 minutes or so of our conversation, no doubt thinking I was one of those who didn't get it. All that said, I enjoy the topic and although I am passionate about it, I don't think discussion falls easily into party lines so one can discuss these things rather freely. Crap. Reporting is done anyway and part of the problem is that new reports such as those provided for CIHI are 'added on'. They actually hire people to get data twice, and to ask questions of people who ask other people questions. There's no cohesive information design that undertaken. A mess. I heard a prominent hospital head on CBC Toronto a few months back and he talked about bringing in some other disciplines to their service design ... and (of course) drastically improving the situation by offering 24 access to MRIs ( I think that was the example, although now it seems to me that it may have been different. IN any case....) I was basically shocked that they had been running their services in a bubble for this long (It's 2010 !) and not reaching out for expertise in other areas. This is one thing that competition would alleviate, but if we don't want to privatize then we have to open up the system to analysis and scrutiny. Otherwise, it's just the system watching itself.

See it's not just Canucks fascinated with Yankees...

That's right. So there's no way to get consistent and quality-controlled performance information that is easily accessible and understandable. If I want to find out how the Kansas City Royals are doing, on the other hand, no problem. There's even a free newspaper within 5 minutes' walk of wherever I am, if I am not web literate. This is an example of a cultural blockage that prevents us from reaching excellence: "We don't want to bother anybody" Meanwhile, the rest of the economy has undergone a transformation over the past 20 years to become more efficient and service oriented. Unless we make our public institutions similarly change, they will crash and privatization will be the only alternative.

Just came over the wire that Pamela Anderson married it.

Successes don't appear, nor do failures really. You'll get the odd news item - but ask anybody where they would go to find out performance statistics on health services and you'll get a blank stare. People don't follow it. And Ontario's success is highly suspect IMO. For one thing, it wasn't significant, and for another the improvement is self-reported, as in "How'd you do Dalton ?" "Great !" The reporting systems tend to be asterisked to the nth degree, which to me indicates they've dropped out damaging data. We need independent, widely followed and easy-to-understand metrics that are frequently kept. We don't criticize health services and monolithic things enough. Rogers and Bell Canada at least have each other to compete against but often have no recourse when the system fails. I heard about eHealth when it happened, yes, especially the part about expensing the tea and muffin. Since then, nothing. And before then very little - despite the fact that they were years late and over budget.

Are you just basing this on people you know - or are you an insider ? It's just... the service levels you specify in your post seem pretty specific.

Canadians don't criticize how large institutions like this are run, nor do they hold government to account for big screw-ups in running these things ? Need proof ? eHeath ? The gun registry ? How about McGuinty's promise to reduce wait times - which he made when he was running against Ernie Eves ? Hmmmmmm. Status Quo keeps the Toronto Star and the masses happy, as far as I can tell. No one even complained when McGuinty announced that they weren't going to investigate eHealth. Far from it - it wasn't even widely reported. That was $1B wasted. And the BIG scandal hit because somebody submitted an expense request for tea. I'm quite aggravated by people's faith in the system when it is run virtually without public interest.

Where did you get that ?